Guidelines for the management of paediatric burns

Transcription

1 Guidelines for the management of paediatric burns Are there signs of airway injury? If yes contact anaesthetist! Is burn TBSA >10% If appropriate COOL THE BURN! Heat room. Insert IVC. Obtain FBC, U&,E s, CRP Blood Glucose, G&S & Toxic shock titres. Commence maintenance fluids Commence resus fluid following APLS guidelines Wrap wounds in cling film Administer analgesia Contact Surgical Registrar on call at Yorkhill to arrange transfer Is transfer going to be delayed? Heat room Wrap in cling film Administer analgesia. Contact Surgical Registrar on call at Yorkhill to arrange transfer. Is burn TBSA >3% Is burn >1% full thickness? Does it it involve hands, face, feet, perineum or joints? Is burn full circumferential? Is burn electrical/chemical? Are there child protection issues? (refer to local child protection policy) Deroof blisters and apply a non-adherent dressing Continue care as above Wrap in cling film Deroof blisters. Cleanse and Administer analgesia swab wound. Apply urgotul ssd Contact Surgical Registrar and a suitable secondary on call at Yorkhill to arrange dressing. Patient can go home transfer with appropriate follow up. Check immunisation status Medical Illustration

2 CRITERIA FOR REFERRAL OF PAEDIATRIC BURNS If there is any doubt regarding the management of burns then contact the surgical registrar on call at Yorkhill Hospital. Burn requiring admission to Yorkhill Hospital Any burn >3% TBSA Full thickness burns >1% Burns to hands, face, feet, perineum or joint involvement High voltage electrical injury Chemical injury Airway involvement Burns with associated significant injury Any burn suspected of being non accidental Circumferential burns Burns that do not require admission that need review in the burns clinic Superficial dermal burns <3% which may need physio input e.g. hands, feet or over a joint. Burns <3% with doubt regarding depth of injury Deep dermal / Full thickness injuries <1% An appointment for the Tuesday multi-disciplinary burns clinic or Friday nurse run burns clinic at Yorkhill should be made for these patients if they have been assessed as being suitable for outpatient management. Appointments can be made by faxing a copy of the emergency card to medical records appointments on Children who can be managed in the community Superficial dermal burns <3% which do not require admission to the burns unit and do not match criteria for referral to the burns clinic

3 Burn Dressing Guidelines Administer analgesia prior to commencing wound care. Wound care should be carried out in a clean area using aseptic technique. Superficial Dermal <3% TBSA Superficial dermal burn wounds <3% should be treated as follows:- 1. Deroof blisters and debride loose skin 2. Cleanse with warmed normal saline or tap water 3. Obtain wound swabs 4. Apply a non-adherent dressing (as per local wound formulary). Use an anti-microbial dressing if required. 5. Apply a secondary dressing of gauze/burns swabs and crepe bandage if required 6. Reassess wounds after hours and redress as above 7. Further dressing changes should be carried out as dressing application guidelines dictate or if exudate strikes through or infection is present. Wounds should be redressed until area is completely re-epithelialised. 8. Apply moisturiser and massage healed skin 3-4 times daily following healing.

4 USEFUL CONTACTS YORKHILL HOSPITAL MAIN SWITCHBOARD SHARON RAMSAY- BURNS NURSE SPECIALIST OR CALL MAIN SWITCHBOARD AND ASK THEM TO PAGE 8361 PLASTIC SURGERY SECRETARY FAX or

5 Children s minor burns- advice leaflet Children s minor burns- advice leaflet Looking after your child s burn Looking after your child s burn Dressings Dressings Your child s burn has been covered with a dressing which aims to keep the burn clean and Your child s burn has been covered with a dressing which aims to keep the burn clean and dry and dry and help prevent infection. help prevent infection. It is important that you keep the dressing on. It is important that you keep the dressing on. If it gets wet, becomes stained from oozing, smelly or loose, it will need to be changed. If it gets wet, becomes stained from oozing, smelly or loose, it will need to be changed. This can be This can be arranged by first contacting your GP Practice Nurse or if an appointment is not arranged by first contacting your GP Practice Nurse or if an appointment is not available, re-attend available, re-attend the Emergency Department. the Emergency Department. Pain Pain Most children do not have much pain once the dressing is on Most children do not have much pain once the dressing is on If the burn is still painful, give your child paracetamol (eg calpol ) and/or ibuprofen (eg junofen ) as directed by the bottle. If the burn is still painful, give your child paracetamol (eg calpol ) and/or ibuprofen (eg junofen ) as directed by the bottle. Seek medical advice if the burn becomes more painful. Seek medical advice if the burn becomes more painful. Itch Itch This can be made worse by overheating- try not to overdress your child especially at night. This can be made worse by overheating- try not to overdress your child especially at night. Ensure that fingernails are trimmed to prevent damaging the skin further by scratching. Ensure that fingernails are trimmed to prevent damaging the skin further by scratching. An antihistamine medicine may help with the itch, see your GP or local pharmacist for advice. An antihistamine medicine may help with the itch, see your GP or local pharmacist for advice. Follow up Follow up You may have been asked to return to the Emergency Department or attend your Practice nurse for You may have been asked to return to the Emergency Department or attend your Practice review. It is wise to give a dose of painkiller prior to attending. nurse for review. It is wise to give a dose of painkiller prior to attending. Bring your child back to the Emergency Department immediately in the event of any of the Bring your child back to the Emergency Department immediately in the event of any of the following: following: Fever (more than 38.5 c) Fever (more than 38.5 c) Nausea or vomiting Nausea or vomiting Diarrhoea Diarrhoea Red skin rash Red skin rash Confusion/ Drowsiness Confusion/ Drowsiness As these symptoms may indicate an infection related to the burn injury called toxic shock syndrome. As these symptoms may indicate an infection related to the burn injury called toxic shock syndrome. Once the dressing is removed The healing skin will be dry and flaky and we advise you apply un-perfumed moisturiser (eg E45) twice daily. Never apply to broken/ weeping skin. Long term management Skin which has been burned is at greater risk of damage from the sun. Try to cover exposed areas or apply sun block to the area of previously burned skin. Once the dressing is removed The healing skin will be dry and flaky and we advise you apply un-perfumed moisturiser (eg E45) twice daily. Never apply to broken/ weeping skin. Long term management Skin which has been burned is at greater risk of damage from the sun. Try to cover exposed areas or apply sun block to the area of previously burned skin. Most minor burns heal without difficulty in days. If you are worried contact either your own GP or the Emergency Department on RAH , IRH Most minor burns heal without difficulty in days. If you are worried contact either your own GP or the Emergency Department on RAH , IRH